Overview of Formulary Management Practices of Publicly Funded Provincial and Territorial Drug Plans


( Last Updated : May 12, 2021)
Project Status:
Completed
Project Line:
Health Technology Review
Project Sub Line:
Environmental Scan
Project Number:
ES0354-000

Details


Each federal, provincial, and territorial (FPT) public drug plan provides access to prescription medications for specific populations. FPTs rely on guidance from health technology assessment agencies such as CADTH; however, reimbursement decisions for individual medications follow different local processes. This Environmental Scan sought to compare these reimbursement decision-making processes (e.g., drug review processes, decision-making principles and/or frameworks, decision-making committee structures).

Decision-making processes were evaluated for all provinces as well as for Yukon and the Non-Insured Health Benefits (NIHB) program. Decision-making processes were stratified for oncology versus non-oncology medications as well as for CADTH review–eligible versus CADTH review–ineligible products.

There were 2 models of decision-making processes with a geographic divide: local expert committees reviewing all new drug submissions (Western model) versus reviewing only drug submissions out of scope for CADTH (Eastern model). If decision-making processes were to be harmonized across FPTs, there would need to be a balance between local autonomy versus centralization.